Healthcare Provider Details

I. General information

NPI: 1003111279
Provider Name (Legal Business Name): NAOMI STUART RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2011
Last Update Date: 01/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 HAMMERSMITH DR
WINTERVILLE NC
28590-7061
US

IV. Provider business mailing address

1507 HAMMERSMITH DR
WINTERVILLE NC
28590-7061
US

V. Phone/Fax

Practice location:
  • Phone: 252-439-0986
  • Fax:
Mailing address:
  • Phone: 252-439-0986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License NumberL0001515
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: